The proposed study is concerned with the consistent policies which underlie diabetes management decision making. The first component will develop methods of eliciting and representing physicians' clinical decision-making policies. The second component will develop methods of eliciting and representing patients' policies. A third component will assess the impacts and correlates of different policies and of congruent and incongruent physician/patient policies on patient quality of life and biomedical outcomes. In year one, 24 patients and 24 physicians will be interviewed to identify the primary decisions and decision-making of diabetes management from their perspectives. In year two, 200 physicians will be screened to provide an intensive study sample of 24 physicians for process-tracing and statistically based "policy capturing" studies. Five patients of each of these 24 physicians will be screened and assessed with respect to biomedical control, health status, and quality of life. In year three, a subsample of 24 of these patients will be used for intensive process-tracing and statistically based "policy-capturing" studies. Also in year three, a subsample of eight physician-patient dyads will be studied intensively in relation to doctor-patient policy congruence and development of experimental interventions. A series of preliminary studies of both patients and physicians have developed and tested all of the proposed techniques. The results of the proposed study will supply fundamental information on how the central actors in diabetes management conceive of the issues, reach decisions, and accommodate to each others' perspectives. Such knowledge is basic to development of effective programs of both professional and patient education. The insights and the techniques will be of immediate relevance to other chronic diseases such as obesity or hypertension where disease management presents refractory problems.